Claim Process of ICICI - Health Advantage Plus Claim Process

Claim Process :
Need to fill up the Pre-Authorisation Form & Claim Form

Health - Cashless Settlement
Cashless claims facility is available only at ICICI’s network hospitals. This list of network hospitals will be enclosed with your policy. Under this facility you just sign the bills at the time of your discharge and ICICI shall settle the amount directly with the hospital.Under cashless facility, claims can be of two types:

Planned:
Where the insured or covered family member(s) is aware of the hospitalization 2-3 days in advance.
Contact ICICI’s Third Party Administrator (TPA) TTK Health Services help-line, the same is mentioned on the Health Identity Card.

Fax / submit the pre-authorization form to TPA with doctor’s comments. This form is available at all network hospitals of ICICI.

The TPA faxes pre-authorization form with approval within 2-3 hours.

Avail the health treatment.

On your discharge, the TPA settles bills with the hospital.

Emergency:
Where the insured or covered family member(s) meets with a sudden accident or suffers from a bout of illness that requires immediate admission to the hospital.
Rush the patient to the hospital.

Patient avails the treatment.

Family submits the pre-authorization form to TPA with doctor’s comments. This form is available online and with all network hospitals.

The TPA faxes pre-authorization form with approval within 2-3 hours.

On discharge, the TPA settles bills with the hospital.

Health - Reimbursement Settlement
Reimbursement claims facility is available at both the network and non-network hospitals. The reimbursement claims process is as follows:
Patient avails the treatment.

Settle the hospital bills directly by paying the relevant charges.

Submit the relevant bills / documents for the claimed amount to the TPA.

The claims will be settled in 7 working days, from the time of submission of bills.

Documents Required
Duly completed claim form (available with all network hospitals).

Original bills, receipts and discharge certificate / card from the hospital.

Bills from chemists supported by proper prescription.

Investigation test reports and payment receipts, supported by the note from attending medical practitioner / surgeon prescribing the test.

Doctor’s referral letter advising hospitalization in non-accidental cases.

Nature of operation performed and surgeon’s bill and receipt.

Any other documentation / information as required by the TPA.